Prevalence of Prediabetes and Diabetes and Metabolic Profile of Patients With Nonalcoholic Fatty Liver Disease (NAFLD)

被引:203
作者
Ortiz-Lopez, Carolina [1 ]
Lomonaco, Romina [2 ]
Orsak, Beverly [1 ]
Finch, Joan [3 ]
Chang, Zhi [1 ]
Kochunov, Valeria G. [4 ]
Hardies, Jean [4 ]
Cusi, Kenneth [1 ,2 ,3 ,5 ]
机构
[1] Univ Texas Hlth Sci Ctr San Antonio, Div Diabet, San Antonio, TX 78229 USA
[2] Univ Florida, Div Endocrinol Diabet & Metab, Gainesville, FL USA
[3] Audie L Murphy Vet Adm Med Ctr, San Antonio, TX USA
[4] Univ Texas Hlth Sci Ctr San Antonio, Res Imaging Ctr, San Antonio, TX 78229 USA
[5] Malcolm Randall Vet Adm Med Ctr, Gainesville, FL USA
关键词
INSULIN-RESISTANCE; SECRETION; MELLITUS; OBESITY; GLUCOSE; STEATOHEPATITIS; LIPOTOXICITY; PATHOGENESIS; ACIDS;
D O I
10.2337/dc11-1849
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE-Prediabetes and type 2 diabetes mellitus (T2DM) are believed to be common and associated with a worse metabolic profile in patients with nonalcoholic fatty liver disease (NAFLD). However, no previous study has systematically screened this population. RESEARCH DESIGN AND METHODS-We studied the prevalence and the metabolic impact of prediabetes and T2DM in 118 patients with NAFLD. The control group comprised 20 subjects without NAFLD matched for age, sex, and adiposity. We measured 1) plasma glucose, insulin, and free fatty acid (FFA) concentration during an oral glucose tolerance test; 2) liver fat by magnetic resonance spectroscopy (MRS); 3) liver and muscle insulin sensitivity (euglycemic insulin clamp with 3-[H-3]glucose); and 4) indexes of insulin resistance (IR) at the level of the liver (HIRi=endogenous glucose production X fasting plasma insulin [FPI]) and adipose tissue (Adipo-IRi=fasting FFA X FPI). RESULTS-Prediabetes and T2DM was present in 85% versus 30% in controls (P < 0.0001), all unaware of having abnormal glucose metabolism. NAFLD patients were IR at the level of the adipose tissue, liver, and muscle (all P < 0.01-0.001). Muscle and liver insulin sensitivity were impaired in patients with NAFLD to a similar degree, whether they had prediabetes or T2DM. Only adipose tissue IR worsened in T2DM and correlated with the severity of muscle (r = 0.34; P < 0.001) and hepatic (r = 0.57; P < 0.0001) IR and steatosis by MRS (r = 0.35; P < 0.0001). CONCLUSIONS-Patients with NAFLD may benefit from early screening for T2DM, because the prevalence of abnormal glucose metabolism is much higher than previously appreciated. Regardless of glucose tolerance status, severe IR is common. In patients with T2DM, adipose tissue IR appears to play a major role in the severity of NAFLD.
引用
收藏
页码:873 / 878
页数:6
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